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<br /> <br />PUBLIC ENTITY <br />SIGNATURE PAGE <br /> <br />Covered Party: <br /> <br />City of Sunny Isles Beach <br /> <br />Agreement Number: <br />Coverage Period: <br /> <br />PK2FL1 0132026 O~7 <br />From: 10/0112009 <br /> <br />To: 10/0112010 <br /> <br />I hearby confirm that limits/coverages as shown hereunder, corresponding with the Coverage Agreement, are <br />correct: <br /> <br />o Property TIV <br /> <br />o Inland Marine <br /> <br />$26,820,600 Buildings & Contents Combined <br /> <br />o <br />~ <br /> <br />Not Included Communication Equipment <br />$174,019 Contractor's I Mobile Equipment <br />$600,000 Electronic Data Processing Equipment <br />Not Included Emergency Services Portable Equipment <br />$370,637 Fine Arts <br />$754,000 Other Inland Marine <br />$50,000 Rented, Borrowed, Leased Equipment <br />$1,000,000 Valuable Papers <br />$219,400 Watercraft <br />I reject property TRIA (Terrorism Risk Insurance Act) coverage <br /> <br />Automobile <br /> <br />124 # of Units - Auto Liability <br />124 # of Units - Comprehensive <br />124 # of Units. Collision <br /> <br />o <br />~ <br /> <br />I hereby confirm that I have received a copy of PGIT's Current Interlocal Agreement (effective <br />October 1 , 2004) <br /> <br />I confirm havIng read and agreed to the terms as laid out in the attached PGIT Participation <br />Agreement (which also requires a signature) <br /> <br />Please remember that a signed copy of the following are also required: <br />· First Page of PGIT application <br />· Uninsured Motorist Rejection / Election form, if applicable <br />· Professional Liability (POL / EPLI or ELL / EPLI) application, if applicable. <br /> <br />Signature <br /> <br />TIUe <br /> <br />Date <br /> <br />Name <br />Please note: Failure to return this signature page could result in cancellation of coverage. <br /> <br />The b"1of deso1paon of ~ contIlneclln this docunonlls being powlded as an KCOIIlIPIOCIatI only end is nollntenCled II) COYtr Of deJo1be 81' CDver.I9t Ag/oemont Ie"".. Fer """ <br />a:mplell! .nd detailed lnIormalian reIilUng to lite scope and IIrnlts rI aMnge, Pea'" rd'er cI1ect1y to lite CoYer.ge Agree/llellt ctxumerb. Spl!dmen ronns are available upon reQueSt <br />Page 12 <br />